modified lefort 3

[earl25]

Granted, I've never seen your picture, but if multiple top surgeons are willing to do this surgery for you, that means your situation is serious enough to warrant the operation.  And like you said before, implants are just camouflage. 

The next question is, what kind of prices are they asking, and how much more expensive is it compared with what they charge for run-of-the-mill orthognathic surgery.

surgeons fee ranges from 13-22k

for ths ones who waNted to do it in hospital,hospital 20-30k

for docs who do it in a surgical facility or accredited officd operating room 2-5k

[overbiter]

surgeons fee ranges from 13-22k

for ths ones who waNted to do it in hospital,hospital 20-30k

for docs who do it in a surgical facility or accredited officd operating room 2-5k

I think this is one surgery you definitely want to have done in a proper hospital. I wouldn't even go with a surgeon who is prepared to do it in an office lol. That just sounds nightmarish to me.

I would love to see a picture of your face by the way. I think everyone on this forum would. I can't believe you are really as bad as you say, and I can't even imagine how you look. You talk about yourself as though you have a monstrous face. I hope it's not true.

[earl25]

I think this is one surgery you definitely want to have done in a proper hospital. I wouldn't even go with a surgeon who is prepared to do it in an office lol. That just sounds nightmarish to me.

I would love to see a picture of your face by the way. I think everyone on this forum would. I can't believe you are really as bad as you say, and I can't even imagine how you look. You talk about yourself as though you have a monstrous face. I hope it's not true.

the guy who said office operating rom, is a big respected name.

i cant post a pic. my overall face has improved sincs my other work,but my midface and orbis are still a wreck

[earl25]

Had a long talk with keller . he doesn't think this surgery Is necessarily dangerous. He also thinks the risk of blindness is very very low since hes done many lefort III and II and never had any vision problems. His main concern is he said its a bad idea to do this surgery by not moving the maxilla also. he said just moving the midface without the maxilla is very technically difficult and he'd be afraid the whole peace would just break apart when being moved.He said that would concern him far more than risk of blindness.

[overbiter]

But why wouldn't you move the maxilla, is it in the correct position at the moment? Does moving the maxilla mean you would need another lower jaw surgery?

[earl25]

But why wouldn't you move the maxilla, is it in the correct position at the moment? Does moving the maxilla mean you would need another lower jaw surgery?

my maxilla is in the correct position.  I really dunno what to do. turvey and keller both said they would never do this surgery without moving the upper jaw with it and said its very technically  difficult to do without moving the jaw. obwesgeser, schendel ,sinn don't think so (I don't know if any of them ever did it tho). I don't know what to do. im so f***cking angry that I was born like this. the orbital rims are so hard to fix when deficient. I always have the option of implants with dr, y but to be honest hes never really had any implant work that wowe me and almost all of his post op photos were taken a few days after surgery so theres still swelling which makes it look better.  I loved Ramirez aesthetic eye and implant work ,but he ost his license in Maryland and 2 ppl died in his care and doesn't have malpractice insurance, imo going to him is out of the question.

[earl25]

part of me thinks if this surgery is so safe/predictable then it would be much more popular , but someone said that's not necessarily true because for the most part people don't like extensive surgeries.even doctors today more and more and moving towards filler for  just about everything because theres no down time. also advances in anesthesia/monitoring etc have made it safer (this actually was taken from a paper by dr chin).

[PloskoPlus]

part of me thinks if this surgery is so safe/predictable then it would be much more popular , but someone said that's not necessarily true because for the most part people don't like extensive surgeries.even doctors today more and more and moving towards filler for  just about everything because theres no down time. also advances in anesthesia/monitoring etc have made it safer (this actually was taken from a paper by dr chin).

A lot of PS looks like a scam TBH.  Face transplant recipients look more like themselves prior to surgery than the donors.  Because Face = Skull. OTOH, look at this way.  Many class III patients still look deficient under the eyes after Le Fort I.  If Le Fort III is not such a big deal over Le Fort I, and trimax surgery is almost the norm now days anyway, why not go the whole hog and do it as well at the time of the jaw surgery?  Because the blond Obwegesser girl in this thread is by far the best Class III outcome I've ever seen.

[earl25]

you are right. beauty is ine bone structure. ppl get so caught up on antiaging and wrinkles but imo its meaningless.

the problem is my upper jaw is in perfect position. so the question is can the lefort 3 be done with just moving midface without the jaw. some docs say yes,some say no.i havent seen any picturss without the jaw moved. obwegesers emails are confusing because he says things like lefort iii plus lefort i, or in my case lefort iii minus lefort i.wtf does that mean. does plus mean its 2 seperate surgery cuts under 1 anesthesia or is it one surgery cutting both. he doesnt respond to me anymore

[earl25]

i was able to find a study on pubmed where jaw wasnt moved .it from asian dr`s and again they write lefort iii minus lefort i

[overbiter]

I suppose the 'minus Lefort I' means a backwards shifting Lefort.

Why can't you get two surgeries? Especially if it's safer for you. Just get your mid face and upper jaw moved forwards, and then later on have the upper jaw moved back. It sounds like the best solution for you.

[earl25]

I assumed it meant not moving the maxilla. when I emailed obwegeser I specifically asked if he can do lefort iii without moving the upper jaw. his response is he can do a lefort III minus lefort I, when I asked him about the girl he said she had a lefort III plus lefort I. unfortunately he no longer responded to my e-mails  after the last one. if anyone can get him to discuss  his lefort III it would be great .

[PloskoPlus]

part of me thinks if this surgery is so safe/predictable then it would be much more popular , but someone said that's not necessarily true because for the most part people don't like extensive surgeries.even doctors today more and more and moving towards filler for  just about everything because theres no down time. also advances in anesthesia/monitoring etc have made it safer (this actually was taken from a paper by dr chin).

OTOH, aren't eye socket and cheekbone fractures fairly common (fights, car accidents) and are fixed with Le Fort 3?

[Gregor Samsa]

Where are the incisions made?

[PloskoPlus]

So I go and see yet another surgeon.  This time I didn't blab who my surgeon was.  He told me that no-one does more surgeries than him in the state, if not the country.

Le Fort I is all I need, and re-evaluate in 12 months.
My face is too wide for modified Le Fort III (it will make it wider).
My cheekbones are asymmetrical.  Le Fort III would exacerbate the asymmetry.  So maybe implants to fix give under-eye support.  But implants suck.  He really regrets putting them into patients when he was younger and was willing to "experiment" at patient's request (and they were the wrong patients - "lunatics", "but, hey no-one sued me").  He only does custom medpor a few times a year when someone's face is totally messed up by an accident.  Other than that, they are evil for the same reason chin implants are bad - "facial bones and muscles want to be together".  Oversize malar implants can in fact cause scleral show.
HA paste is bulls**t as well.  It migrates, resorbs.  Waste of time.

Other interesting tid bits:
BSSO does not change the genial angles, only IVRO does, but it's dangerous and no-one does it anymore.
New planning software now even has ethnicity options.

Modified Le Fort III is only really for syndromal cases (Crouzon and the like).  Says he's done less than 5.  1% risk of blindness.  But he showed me the modified Le Fort III he did on a Class III man. Name, operation pictures (cuts under the eyes) and all.  I asked him "what about patient confidentiality?" - "I don't give a f**k".  The dude looked old and haggard.  Narrow face, eyeballs practically hanging out.  Scleral show.  All fixed.  He did not become handsome, just normal.  Was ugly before.  I really wonder what his real age was.  He looked 50 years old.  Maybe it was because of the deformity.  Anyway the good doc said you can jump one level when you fix your deformity.  Said I was average, will be "good looking, but no model" after surgery.  So if you are ugly due to the deformity, you become average, etc..  Anyway, apparently this dude's personality changed from introvert to extrovert and he lost his job because of it.

I finally mentioned my surgeon.  He said no-one besides US does more orthognathic surgeries. Hehe.  "And we won't ignore you if things go wrong.  Other surgeons just go quiet and will send you for second opinions.  We will fix you if we make a mistake".  So it's either him or my surgeon.  No-one else has their kind of volume of surgeries. 

Said that my surgeon is a real Le Fort III expert, loves doing them and will do them any chance he gets.  So the fact that he doesn't think it's a good idea for me, means that it's not a good idea period.

tldr; From all the non-syndromal modified Le Fort III pictures I've seen, you need to have serious scleral show and have bulging eyes practically hanging out of their orbits.  But it's not the white-unicorn operation that it's made out to be.  Surgeons that know how to perform it, do perform it when it's appropriate.